By X. Ingvar. Nyack College. 2018.

This conclusion is not meant to imply that the principles of Western medicine and traditional diagnostic methods should be disregarded discount zocor 40mg with mastercard cholesterol eyelid. On the All About Mystery Maladies: A New Mind-Set 29 contrary, it may actually be the case that for all the reasons we described in Chapter 1 the problem may arise from those principles and methods not being implemented as they were originally intended to be. In fact, most medical school textbooks, particularly those on the subject of diagnostics, will be the first place young medical students will hear that the practice of medicine is an art. But like any other art, diagnostic skill requires creativity on the part of its creator. Creating any kind of art—whether it’s music, painting, writing, danc- ing, or the practice of medicine—involves a process that combines the skills of the discipline with imagination, observation, thoughtful consideration and discernment, intuition, and an openness to all possibilities. In other words, keeping an open mind and allowing all possibilities to be considered. From the physician’s perspective, in certain cases, this may be as sim- ple as taking the time to understand certain predisposing factors that may render a particular patient vulnerable to a disabling condition or consider- ing potential precipitating and perpetuating factors that may maintain mal- adaptive illness behaviors. Such global thinking may create a consciousness of these factors that eventually allows the clinician to unravel the compli- cated problems that create the patient’s distress. We must be willing to take responsibility for gathering as much information as possible and to be persistent in this effort, regardless of the sources used. You can and should always check out this information with your physician. Every answer to every problem is a series of connections that are made in our minds after observation and the application of knowledge that may come from anywhere, whether it be formal education, life experience, hap- penstance, or creative thinking. If we are married to any preconceived notions, we may never find the answer to our mystery maladies. A perfect example of where an open-minded approach could have saved thousands of dollars and many lives occurred in 1993 during an outbreak of an unexplained bleeding lung condition in an area known as the “Four Corners” (where the state borders of Arizona, Colorado, New Mexico, and 30 Becoming Your Own Medical Detective Utah all meet). Until the medical experts were willing to explore outside their own knowledge base, the case of Four Corners remained unsolved. This story, documented by the CDC’s Special Pathogens Branch, involved a young, physically fit Navajo man who was admitted to the hospital suf- fering from shortness of breath and died almost immediately thereafter. It was discovered that this young man’s fiancée had died with the same symp- toms only a few days earlier. A series of laboratory tests failed to identify any known pathogen, including the one that caused bubonic plague in the Mid- dle Ages. The Special Pathogens Branch of the CDC was notified, and the state health departments of all four states—as well as the University of New Mex- ico School of Medicine—became involved in trying to solve what rapidly became an outbreak of the mysterious disease. During the ensuing weeks, as additional cases were reported and many people died, physicians and other scientific experts worked intensively to narrow down a list of suspected causes. These included exposure to herbicides or the possibility of a new type of influenza virus. Finally, the virologists at the CDC linked this pul- monary syndrome with a previously unidentified type of hantavirus.

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Emergency solutions Sometimes plans go astray and you will need to take emergency action: ° Running out of time – jot down order 10mg zocor otc cholesterol nutrition facts, in note form, the points that would have completed your essay. Indicate you know that the information is from another source by using a general reference like ‘researchers have found’. For example, if you have forgotten the side effects of a drug, describe how you would find them out. Summary Points ° Summative assessments are set at the end of a study unit, term or academic year. It is distinguished from other essays submitted as coursework by its length and detailed treatment of its subject. Each student will make their own choice of topic, unlike set essays where all the students answer the same question. The content of the dissertation will represent the student’s independent study of the subject matter, and will extend beyond the theory and practical applications for­ merly taught on the course. Writing a dissertation provides the student with an opportunity to: ° study in depth one particular aspect of a subject ° learn the process of academic enquiry ° develop his or her thinking about a specific subject ° deal with a large amount of information ° be able to express ideas coherently ° sustain a discourse throughout a lengthy composition. Choosing a title Unlike set essays, where the question is chosen by the examiner, the stu­ dent decides on the title for his or her dissertation. Although this is often the most challenging part of the task, it is important to get it right as it will shape both the structure and content of the essay. For instance, some courses con­ tain advanced study units that involve the completion of a dissertation – so if you are studying ethics, your dissertation will be about some aspect of this. If you have more scope in choosing your topic, you may find Chapter 14 ‘Developing an Idea’ useful. You will have to spend an enormous amount of time and effort in preparing your dissertation. By the completion of your project you may be less than en­ thusiastic about the work, so start with something that really excites you or has some personal significance for you. This will range from access to the appropriate journals and texts to a tutor who can offer you the appropriate supervision in developing your work. Refining the topic Once you have a general idea of your subject matter, you can start to work at determining the focus of your enquiry. Use a brainstorm (see Chapter 5 ‘Letters and Reports’) or a mind map (see Chapter 11 ‘Assessment’) to gen­ erate ideas about different aspects of the topic. For example a brainstorm of ‘cross-infection’ might produce the keywords Staphylococcus aureus, antibi­ otics, wound infections, treatment, infection control measures and methicillin resistant Staphylococcus aureus (MRSA).

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An infected mother has a 15 to reproduce order zocor 20 mg on-line baba ramdev cholesterol yoga, and when protease inhibitors are administered, 25% chance of passing HIV to her unborn child before and HIV replicates are no longer able to infect cells. In 1995 the during birth, and an increased risk of transmitting HIV Federal Drug Administration approved saquinaviras, the first through breast-feeding. Although rare in countries such as the protease inhibitor to be used in combination with nucleoside United States where blood is screened for HIV, the virus can drugs such as AZT; this was followed in 1996 by approval for be transmitted by transfusions of infected blood or blood-clot- the protease inhibitors ritonavir and indinavir to be used alone ting factors. Another consideration regarding HIV transmis- or in combination with nucleosides. The combination of drugs 8 WORLD OF MICROBIOLOGY AND IMMUNOLOGY AIDS, recent advances in research and treatment brings about a greater increase of antibodies and a greater per microliter of blood, the number of infective virus particles decrease of fulminant HIV than either type of drug alone. This Although patients improve on a regimen of mixed drugs, they loss of the ability to fight off foreign organisms leaves the are not cured due to the persistence of inactive virus left in the patient open to life-threatening illnesses that normally would body. Researchers are looking for ways to flush out the be routinely defeated by an unimpaired immune system. In the battle against AIDS, researchers are also Until 2001, the prevailing view was that the decline in attempting to develop a vaccine. As an adjunct to the classic the number of CDC4 cells was due to a blockage of new T cell method of preparing a vaccine from weakened virus, scientists production by the infecting virus. However, the conclusions are attempting to create a vaccine from a single virus protein. Even though the result is viduals pass HIV-laden macrophages and T lymphocytes in the same, namely the increased loss of the specialized AIDS- their bodily fluids to others. Sexual behaviors and drug-related fighting T cells, the nature of the decline is crucial to deter- activities are the most common means of transmission. Commonly, the virus gains entry into the bloodstream by way If the reasons for the accelerated loss of the T cells can be of small abrasions during sexual intercourse or direct injection determined, perhaps the loss can be prevented. In attempting to prevent HIV trans- better equip patients to fight the infection. Highly Active Anti-Retroviral Therapy programs; it is vitally important to increase public under- (HAART) consists of administering a “cocktail” of drugs tar- standing of both the nature of AIDS and the behaviors that put geted to the AIDS virus to a patient, even when the patient individuals at risk of spreading or contracting the disease. The drug mixture typically con- tains a so-called nucleoside analog, which blocks genetic See also AIDS, recent advances in research and treatment; replication, and inhibitors of two enzymes that are critical Antibody and antigen; Blood borne infections; Centers for enzyme in the making of new virus (protease and reverse tran- Disease Control (CDC); Epidemics, viral; Human immunode- scriptase). Immunodeficiency diseases; Immunological analysis tech- But, this benefit has come at the expense of side effects that can niques; Infection and resistance; Infection control; Latent often be severe. But now, viruses and diseases; Sexually transmitted diseases; T cells or research published toward the end of 2001 indicates that the use T lymphocytes; Viral genetics; Viral vectors in gene therapy; of HAART in a “7-day-on, 7-day-off” cycle does not diminish Virology; Virus replication; Viruses and responses to viral treatment benefits, but does diminish treatment side effects. Another advancement in AIDS treatment may come from the finding that the inner core of the AIDS virus, which AIDS, RECENT ADVANCES IN RESEARCH is called the nucleocapsid, is held together by structures AND TREATMENT known as “zinc fingers. Acquired Immune Deficiency Syndrome (AIDS) has only been Furthermore, evidence supports the view that the nucleocapsid known since the early years of the 1980s.

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The patient has to go back on long-term bed rest and repeat hospitalization zocor 10 mg visa cholesterol medication harmful. The insurance companies seem to be short-sighted, preferring to spend money on surgical intervention rather than paying for the right cushion and specialized wheelchair—which would ultimately save dollars and help the patient return to a productive and indepen- dent life. Unlike physical and occupational therapy, most mobility aids will not im- prove baseline physical function (although they certainly may enhance safety and ambulation techniques). Judgments of medical necessity there- fore cannot rely on that traditional standard of restoring function. For Medicare, the focus shifts to whether the equipment allows someone to perform minimal activity—moving around within one’s home. Medicare Part B “pays for the rental or purchase of durable medical equipment” only “if the equipment is used in the patient’s home or in an institution that is used as a home” (42 C. Getting around outside the home is a “convenience,” not medically necessary, as Erna Dodd found. By this stringent standard, many people with progressive chronic con- ditions who still get around inside their homes (e. To obtain a “power operated vehicle” (POV)8 for their patients, physicians must complete the “Certificate of Medical Necessity” (Form HCFA 850[4/96] and OMB No. Have all types of manual wheelchairs (including lightweights) been considered and ruled out? Thus, Medicare’s intent is clear: to pay for the more expensive POV only if cheaper options are “ruled out. A social worker told me of a man para- lyzed by a stroke whose POV request was refused. Medicare asserted that his elderly wife could push him in a manual wheelchair within their home—never mind that she is also frail and weak. Compared to certain other types of DME, POVs are relatively rarely requested, and no evidence suggests that they are overprescribed (Wickizer 1995). As one woman whose husband has severe MS said, “I don’t believe there’s a massive abuse of DME—that people are buying things that they don’t need. The medical di- rector of a midwestern health insurer (mentioned earlier) told me he does not argue with wheelchair prescriptions for people with stroke or spinal cord injury—the most common conditions generating these requests. If their arms are paralyzed or weak, he also does not question the medical ne- cessity of powered equipment. But he wonders how one really decides what is medically necessary when there are so many technological options. They want the Cadillac models when they don’t really, in our view, need the full Cadillac model. We always go back to the clini- cian ordering the wheelchair and ask them to justify it.

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